Transgender

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What is gender?

Gender is a complex concept encompassing an individual’s identity. Initially, it was used as a way to differentiate male from female, between masculine and feminine. However, gender is not a binary — and it is not an easy word to define. There are many components to its definition, including biology, genetics, behavior patterns, activities, social identity, and psychological traits. Society associates many of these characteristics with one sex, either male or female. During the earlier decades of the 20th century, the concepts of transgenderism, gender dysphoria, or even transgender hormone therapy were still far from reality. 

However, in 1955, gender was first described in terms of sexual roles by John Money, a doctor specialising in research into the biology and psychology of gender. He also used the term gender identity for the first time in 1966 to describe a person’s subjective sense of their own sex, which may not be the same as their physical gender based on the genitals they were born with.

Then, in 1974, the term “gender dysphoria” was first used to describe the distress that can be felt by a person who is dissatisfied or discontented with the physical sexual identity they were born with or the sexual role in society that is expected of them and this is also known as gender identity disorder. Coining these terms helped deepen the understanding of transgenderism — that there are people who have a gender identity that does not match their biological sex and includes people described by the categories of transsexual or transgender. Furthermore, bringing these concepts to light paved the way for sexual transition through processes like transgender hormone therapy, allowing people to live completely in accordance with their identity.

Transgender or transsexual

A transgender describes a person who lives within their body and is not necessarily male or female, but may incorporate both male and female behavior and appearance. They usually do not wish to have genital surgery and manage their gender identity by the way they dress and how they present themselves. However, they may still want to undergo hormone replacement therapy for transgenders to develop characteristics that are more feminine or masculine, depending on their gender identity.

A transsexual is someone who has a gender identity that more closely resembles the opposite sex and they often wish to change their physical sex attributes and live completely as the opposite sex. For a transsexual, the next step would be genital surgery and transgender hormone therapy to complete the gender reassignment process.

Gender reassignment

The term gender reassignment refers to the process whereby the physical sexual characteristics are altered to reflect a person’s gender identity.  This process of change from the one gender to another, also known as transition, incorporates medical procedures, hormone replacement therapy and social changes, such as the person’s role and legally changing their name to one that better suits the opposite gender.

The genetics of gender 

Gender is determined by several factors, including hormones present during fetal development, reinforced behavior patterns as well as genetics. While genetics usually determines gender, XX being female and XY being male, there are other genetic combinations that introduce shades of gray. Some of these change the physical appearance, such as XXY, which results in male and female genitals and is known as Klinefelder’s syndrome. The genetic makeup XYY results in male genitals but can also cause various antisocial or aggressive behaviors. The genetic makeup XO or Turner’s syndrome results in a female body but behavior and personality are affected.

The role of hormones in sex and gender

Transgender hormone therapy is crucial for individuals seeking to develop more feminine or masculine characteristics, as hormones play a vital role in shaping and aligning physical attributes with their gender identity. Remember that the term “sex” refers to the biological difference between the male and female body. However, gender refers to the expected behavioural and cultural differences within society that are determined by a person’s sex. Without interventions like medical transitions, a person’s sex does not change but gender can.

The physical differences between males and females develop in response to steroid hormones, which begin influencing development before birth. All fetuses develop along female lines until testicular hormones initiate male differentiation. Although estrogen is considered the female hormone, testosterone is also present in females but in lesser amounts. It is the higher levels of testosterone in males that determine the development of male physical changes and also influence brain development, which ultimately influences behavior. At puberty, female secondary sexual characteristics are induced by estrogen and progesterone produced by the ovaries. Meanwhile, male secondary sexual characteristics are induced by androgens, particularly testosterone and its potent metabolite dihydrotestosterone or DHT produced by the testes.

Transgender hormone pills and other interventions allow individuals to induce hormonal changes that align more closely with their gender identity. These are known as feminization and masculinization regimens. At InhousePharmacy.vu, our Transgender category contains feminizing products like estrogen and anti-androgen pills. These transgender drugs work to influence body fat distribution, skin texture and breast development. Individuals desiring a more masculine appearance may be prescribed testosterone pills to promote facial and body hair growth, deepening of the voice and muscle development.

Feminization regime

Transgender hormone therapy tailored for male-to-female individuals is often referred to as feminization or a feminizing regimen. It involves a strategic approach to modify physical characteristics using transgender hormone pills. These medications suppress original male attributes by blocking male hormones while simultaneously stimulating the development of female secondary sexual characteristics using female hormones. A comprehensive feminizing programme encompasses multiple hormonal interventions, each playing a distinct role in one’s transition.

The effects of transgender hormone therapy for male-to-female individuals include:

• redistribution of body fat to redefine body shape
• breast development
• reduction in appearance and coarseness of body hair
• reduced musculature in the hands and feet
• changes in appearance of the skin
• reduced activity of the sebaceous glands

Overall, these changes brought about by transgender hormone pills lead to a more feminine appearance and less pronounced masculine features.

Products for feminisation hormone therapy

Feminizing hormone therapy involves a carefully curated drug regimen designed to bring about your desired physical changes. Before you purchase transgender hormone pills for feminization, it is important that you seek medical guidance throughout your journey. A licensed endocrinologist can design a feminization programme that suits your goals, while psychologists can help you cope with the emotional and social challenges that come with your transition.

When you’re ready, these are the common medications involved in transgender hormone therapy for male-to-female transitioners:

• Estrogens — These primary female sex hormones play a pivotal role in promoting female secondary sexual characteristics, and its most potent form is estradiol. Estrogens contribute to breast development, redistribution of body fat and developing a softer skin texture.
  Estrogens can be administered in different ways: orally through transgender hormone pills; transdermally with patches, creams and gels; and through injectables.
• Anti-androgens — These are integral to feminizing hormone therapy, aiming to reduce the effects of male hormones, especially testosterone. Anti-androgens suppress masculine characteristics, including facial hair growth, deepening the voice and high muscle mass.
• Anti-androgens are another type of transgender drug administered in pill form.
• Progestins — Progestins, synthetic hormones derived from naturally occurring progesterone, help promote the feminization process. They are taken orally through pills. 
• Combination estrogen and progesterones — The combination of estrogen and progestins seeks a more balanced approach to feminization, counteracting some of the risks of estrogen alone. Additionally, it allows for further breast development and enhancement of other feminine features. Combination hormones are typically administered through oral pills.

FAQs

What is transgender hormone therapy, and why is it important?

Transgender hormone therapy involves the administration of hormones to align an individual's physical characteristics with their gender identity. For transgender individuals, this process is crucial for achieving a more authentic expression of their gender. It helps them fight issues like gender dysphoria and improve their overall well-being.

What happens if a man takes estrogen every day?

If a cisgender man takes transgender hormone pills like estrogen regularly, it can lead to the development of feminine secondary sexual characteristics. They may see changes such as breast growth, softer skin, and a different fat distribution. However, it's important to note that self-administering transgender drugs without professional guidance can have unpredictable and potentially harmful effects. For a successful transgender hormone therapy, please consult with a licensed endocrinologist.

Does estrogen change your face?

Yes, estrogen can contribute to changes in facial appearance during the feminizing process. These may include a softening of the skin, reduction in facial hair, and alterations in fat distribution.

Is feminizing hormone replacement therapy permanent?

Generally, yes, the effects are permanent. However, some changes, such as fat distribution and muscle mass reduction, may be reversible if hormone therapy is discontinued.

How long does hormone therapy for transgender individuals take?

The duration of hormone therapy varies widely. Changes typically begin within the first few months of the feminization or masculinization process, but the full effects may take one to two years or more. The process is gradual and continues over an extended period to allow for a more natural and sustainable transition.

How does one choose the right hormone therapy regimen?

The choice of hormones should be guided by healthcare professionals specializing in hormone replacement therapy for transgenders. It is highly personalized based on your desired features, health goals, and social preferences.

Are there risks associated with transgender hormone therapy?

Hormone replacement therapy for transgenders is generally safe under professional guidance. However, there are potential risks, including cardiovascular issues and changes in mood or mental health. Regularly monitor and communicate your condition with healthcare providers to address and mitigate these risks.